Care Coordinator - HUD

Care For the Homeless; New York (NY); On-site; USD 60,000 - 69,000; Full time

Job summary

Care For the Homeless in New York, NY seeks a Care Coordinator to coordinate care for chronically ill/high-risk patients, partnering with families, caregivers, clinics, hospitals, and housing specialists to integrate services and ensure HUD grant compliance.

The role includes coordinating referrals, assisting with appointments, housing searches, and non-clinical linkages across CFH Health Centers and transitional facilities. Bilingual English/Spanish preferred.

Qualifications

• Bachelor’s degree in Social Work, Public Health, or a related field.
• Minimum 2 years of experience in housing services or case management.
• Experience in culturally and linguistically diverse settings; health care setting preferred.
• Knowledge of HUD regulations and HUD-funded programs preferred.
• Proficiency with EHR systems or housing management software.

Responsibilities

• Oversee referrals, monitor progress, and ensure follow-through with appointments.
• Assist patients in attending specialized referrals and address barriers to care.
• Schedule, cancel, and coordinate appointments for CFH Health Centers by phone.
• Provide internal referrals and connect clients to community resources.
• Conduct outreach to re-engage patients in care and follow-up services.
• Maintain caseloads and support housing placement and housing applications.

Skills

Organizational skills

Communication skills

Bilingual English/Spanish

Education

Bachelor's degree in Social Work/Public Health

Tools

Electronic Health Records (EHR) systems

Housing management software

Job description

The Care Coordinator position is integral to our integrated care team, dedicated to delivering exceptionalcare coordination services to our patients. This role is particularly focused on collaborating with and continuously supporting individuals who are chronically ill or considered high-risk patients. The Care Coordinator will establish and maintain effective partnerships with patients, their families, caregivers, and with specialty providers, clinics, hospitals, and other healthcare providers. Additionally, they will liaise with community resources to ensure a cohesive approach to healthcare, guaranteeing that all aspects of a care plan, including referrals and support systems, are seamlessly integrated. The Care Coordinator will be responsible for managing and coordinating the care of clients in our transitional and safe haven facilities. This role involves assessing client needs, developing individualized care plans, facilitating access to services, and ensuring compliance with HUD grant requirements. The ideal candidate will have a strong background in healthcare, social work, or a related field and a passion for helping vulnerable populations.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work directly with the referrals team to oversee the monitoring, tracking, and management ofpatient referrals, ensuring follow-through with recommended appointments.
• Support patients in attending specialized referral appointments, addressing potential barriers toensure consistent care.
• Assist patients in managing their appointments at CFH Health Centers, including scheduling andcancellation, via telephone support.
• Provide internal referrals to other services within the organization, along with non-clinicalcommunity referral linkages, and monitor outcomes.
• Conduct targeted outreach to patients requiring follow-up care or screenings, leveraging phonecommunication to ensure timely healthcare interventions.
• Monitor patient compliance with scheduled medical appointments, proactively contacting thosewho have missed appointments or disengaged from care to reconnect them with necessaryservices.
• Provide hands‑on assistance to enable clients to find suitable housing, including accompanyingclients to apartment viewings and conductingneighborhood research throughout NYC andsurrounding areas.
• Advocate on behalf of the veteran with landlords and brokers to overcome any issues orchallenges to securing suitable housing.
• Work collaboratively with community housing specialists to identify suitable housing.
• Conduct housing inspections for identified units prior to financial assistance being requested.
• Utilize Motivational Interviewing, and Harm Reduction techniques to assist both veterans andyoung adults, singles and families who are homeless to resolve their housing crises and promotelong-term housing stability
• Assist with housing search and placement. Provide hands‑on assistance to enable participants tofind suitable housing, including accompanying participant to apartment viewings and conductingneighborhood research throughout NYC and surrounding areas. Advocate on behalf of theparticipants with landlords and brokers to overcome any issues or challenges to securingsuitable housing. Work collaboratively with URRH housing specialist to identify suitable housing.
• Maintain a caseload of up to 25 or more clients.
• Support clients not only through care coordination but also by taking on duties that overlap withHousing Specialists, such as assisting with housing applications, landlord engagement, andconnecting clients to stable housing resources.
• Perform other related duties and responsibilities as assigned; job tasks and responsibilities may be modified or expanded to meet organizational needs.

JOB QUALIFICATIONS

Education:

• Bachelor’s degree in Social Work, Public Health, or a related field (preferred).

Experience:

• Minimum of 2 years of experience in housing services, case management, or a similar role.
• Previous experience providing services and exercising leadership in a culturally andlinguistically diverse setting, with demonstrated success.
• Prior experience in a health care setting, preferably FQHCs, strongly preferred.
• Knowledge of HUD regulations and experience with HUD-funded programs (preferred).
• Proficiency in using Electronic Health Records (EHR) systems or housing managementsoftware.
• Excellent organizational and communication skills.
• Ability to work effectively with a diverse population.
• Strong problem-solving skills and ability to respond to crises.

Skill Sets:

• Strong organizational skills: Able to manage diverse responsibilities and provide services at various sites.
• Ability to establish and maintain effective working relationships with colleagues, patients, and contracted providers of health care services.
• Strong problem-solving skills and ability to address issues professionally and effectively.
• Excellent oral and written communication skills needed to provide counseling to patients, document case work and provide training.
• Ability to work both independently and within a team environment.
• Bilingual English/Spanish strongly preferred

Pay:

$60,000

Languages:

• Bilingual English/Spanish/French strongly preferred.